Overcoming The Challenges To Achieve Lab Interoperability
Overcoming the Challenges to Achieve Lab Interoperability Provided By: The National Learning Consortium (NLC) Developed By: Karen Williams, BSMT(ASCP), Lab Manager, Internal Medicine of Northern Michigan Date Version 1.0
National Learning Consortium The National Learning Consortium (NLC) is a virtual and evolving body of knowledge and resources designed to support healthcare providers and health IT professionals working towards the implementation, adoption and meaningful use of certified EHR systems. The NLC represents the collective EHR implementation experiences and knowledge gained directly from the field of ONC’s outreach programs (REC, Beacon, State HIE) and through the Health Information Technology Research Center (HITRC) Communities of Practice (CoPs). The material in this document was developed by Regional Extension Center staff in the performance of technical support and EHR implementation. The information in this document is not intended to serve as legal advice nor should it substitute for legal counsel. Users are encouraged to seek additional detailed technical guidance to supplement the information contained within. The REC staff developed these materials based on the technology and law that were in place at the time this document was developed. Therefore, advances in technology and/or changes to the law subsequent to that date may not have been incorporated into this material. www.HealthIT.gov Date Version 1.0 1
Description & Instructions The Overcoming the Challenges to Achieve Lab Interoperability PowerPoint is intended to aid providers and health IT implementers with achieving lab interoperability. www.HealthIT.gov Date Version 1.0 2
Internal Medicine of Northern Michigan 11 Provider Internal Medicine Practice In house Physician Office Lab EMR Go Live –March 16, 2011 Located in Petoskey, Michigan overlooking Little Traverse Bay. www.HealthIT.gov
Lab Challenges Medical Necessity/Frequency ABN (Advance Beneficiary Notice) Mapping Diagnosis to Testing Managing Insurance Based Lab Carve Outs Managing Multiple Lab Service Providers Managing Standing and Future Orders Tracking Result Completion Notifying Patients of Results Satisfying Courtesy Copies to other Providers www.HealthIT.gov
Objectives Objective 1: I will show you how we have set up our orders and interfaces to make them easy to order, keep track of outstanding orders, and easily provide lab reports to colleagues and patients. Objective 2: Our practice owns a lab. I will show you how we’ve made it more efficient by minimizing Medicare and insurance write offs and streamlined the order completion process. Objective 3: Patient friendly lab reports keep our patients informed, more active in their care plans, and reduce the number of phone calls asking for lab results interpretation. Objective 4: I will show you how by investing in the right tools to assist our EMR function to meet the needs of our practice provided an overall savings of time and money. www.HealthIT.gov
The Process Providers: Phlebotomists: Mapping: Results: Order Tests Map Diagnosis Codes to tests Medical Necessity Checking Provide Patient Demographic Information Accurate Patient Identification Review Order/Verify Correct Diagnosis Deal with Insurance Carve Out Rules Obtaining the correct Specimen Label specimens Correctly Send Specimens to the correct lab Get ABN signed Provide completed requisitions to Reference Lab Enter orders in LIS Matching Reports to Correct Patient Chart Data Entry to Flowsheets Tracking Result Completion Patient Friendly Reporting Sharing Reports with Colleagues www.HealthIT.gov
The Beauty of Clean Lab Orders and Bi-directional Interfaces. www.HealthIT.gov
EMR Workflow
ORDER ENTRY Our lab orders were created based on lab order history. Our practice created names that made sense to us. Custom order lists and order sets are created. Created Lab Kits for our lab and reference lab. Created Routing Rules. Medical Necessity Checking based on Lab Rules. www.HealthIT.gov
Medical Necessity Checking www.HealthIT.gov
ORDER COMPLETION Phlebotomist collects the specimen. Completes the order by sending order to lab. Labels/Requisition are designed to meet lab specifications. ABN are also available for printing www.HealthIT.gov
Reporting Results/Lab to EMR Created our results mapping files. Created our flowsheet views (based on lab results). Mapped Reference Lab Compendium with EMR OBS Terms Auto-completion of order in EMR upon provider signature. www.HealthIT.gov
Patient Friendly Reporting Create Patient Friendly Lab Reports that inform the patient about their lab tests by including an explanation not just a number. Reduce Calls from patients asking what the lab report means. www.HealthIT.gov
HTML Enhanced Results The lab report we already know now includes a link that references the HTML enhanced report format It only took a few minutes to configure or “turn on”. HTML report stored on EMR-Link server, so no storage requirements. Forwarding functionality allows HTML report to be sent securely to a patient or other providers via email message. www.HealthIT.gov
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EMR Link Results Report www.HealthIT.gov
Patient Friendly Reporting www.HealthIT.gov
Benefits Our Providers No change to our EMR ordering workflow Medical Necessity Checking Eliminate Duplicate Ordering Allows Standing Order/Future Order Set up Auto-completes the lab order status upon signing the result Supports all of your labs. EMR-Link routes orders to the correct lab (based on insurance or local rules) Our Lab Eliminates data entry for the lab order Eliminates lab call-backs Eliminates chart matching errors when results are returned Single connection through EMR-Link to all labs Clean and complete orders. Medical necessity validated. ABN generated when required Streamlined the Specimen collection process Streamlined the Lab reporting process www.HealthIT.gov
Benefits To Lab Management Reduces or eliminates LIS Management Diagnosis updates Test Menu changes for reference labs Utilization Reporting Result Management To Our Practice Billing Department- reduced time spent correcting orders with missing diagnosis or lacking medical necessity Clinical Assistants-Auto completion reduces open order tracking saving valuable time. Results automatically enter the flowsheets making reporting for Quality Measure reports a breeze. www.HealthIT.gov
Annual Lab Savings Hours Dollars Reduction of Data Entry 5760 69,120 Fewer Order Errors 288 4320 Reduction Correction Medicare Missing Dx 3240 38,880 24 600 9312 112,920 Reduction in LIS Maintenance Total Savings 75% Lab Revenue from Medicare Patients with an average 45/order Clean orders Reduction in Medicare Write offs saving approximately 60,000/yr
Annual Practice Savings Hours Dollars Lab 9312 112,920 Medical Records Matching/Routing Errors 150 1,500 Clinical StaffResult Tracking and Completion 480 7,200 Billing-Reduction of Tracking down DX 540 6,480 Total Savings 9312 128,100 www.HealthIT.gov
How you can help? Hear from everyone in the practice. Encourage practices to ask the tough questions to EMR vendors and do not except “That is not possible.” response. Tell them what you want and need. Be familiar with third party products that can fill in the gaps. Be sure that all involved in the set up have a clear understanding of the goal and are all on the same page. www.HealthIT.gov
Overcoming the Challenges to Achieve Lab Interoperability Author: Department of Health and Human Services, Office of the National Coordinator for Health Information Technology Subject: overcoming challenges to achieve lab interoperability Keywords: ONC, HIT, health information, technology, challenges, lab, interoperability, EMR Created Date
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